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Pathological Laughter and Crying

Dr. Nabi Darya Vali (AIIMS)MBBS

August 27, 2019

January 04, 2021

Pathological Laughter and Crying
Pathological Laughter and Crying

A neurological disease in which patients have uncontrollable and often excessive bouts of laughing, crying or both, Pathological Laughter and Crying (PLC) is also known by five other names: Pseudobulbar Affect, Emotional Dysregulation, Emotional Lability, Emotionalism and Emotional Incontinence.

Researchers have clarified that people living with PLC have difficulty expressing emotions, rather than feeling them. Hence, PLC is not a mood disorder.

Though we don’t yet know how and why PLC happens, there are several theories on potential causes for the disease which manifests as excessive, often inappropriate, laughter or crying, or both—either with or without adequate stimulus.

Symptoms of Pathological Laughter and Crying

Patients with PLC can have episodes of uncontrollable laughter, crying or both. Their emotional response may not indicate how they are actually feeling. They may start laughing or crying suddenly, either with or without a reason or trigger. When there is a trigger, usually their response is excessive: for example, if they would have smiled at something before the onset of PLC, now they may double over with laughter. 

Causes of Pathological Laughter and Crying

Scientists say that PLC may be associated with disturbances in the prefrontal cortex or the neurological pathways in the brain that control emotional responses. Researchers have also suggested the serotonergic (related to serotonin or the happiness hormone) dysfunction may be responsible.

Though the exact physiopathology of PLC is not yet known, researchers have found that some people living with PLC also have other neurological problems, such as:

Diagnosis of Pathological Laughter and Crying

Diagnosis of pathological laughter and crying is done by a neurological expert, usually based on the patient's medical history and their reporting of symptoms. In patients who report inability to control their emotional responses, a mental health expert may also recommend an electroencephalogram (EEG) test to confirm a diagnosis.

Internationally, diagnosticians use tools like the Pathological Laughter and Crying Scale and the Center for Neurologic Study-Lability Scale to record frequency, duration and patients’ control over the episodes of laughter or crying.

Treatment Pathological Laughter and Crying

The underlying mechanism of the disease is not yet known. So, doctors treat for the symptoms. In India, doctors have used antidepressants to manage PLC with limited success. The US Food & Drug Administration has recommended Nuedexta as first-line medicine for PLC.

Early diagnosis and management of PLC are important as patients can often feel embarrassed and can feel cut-off from society.

Takeaways

PLC is a rare disorder, with little public awareness around it. When a patient has a PLC event, the situation can quickly turn awkward. This can lead to embarrassment and social isolation.

In addition to proper medication, people living with PLC can try these methods to navigate social expectations: 

  • Be open about your condition. Talk to people about it, and do not leave them confused
  • Try to distract yourself with work, play, a movie - anything that takes up all your attention - as soon as you feel like laughing or crying without adequate reason. Counting backwards can help some patients avoid a PLC event. Of course, the success of these techniques will depend on how much voluntary control you have over your emotional expressions 
  • Breathing techniques have also been known to help some people living with PLC. When you feel like laughing or crying, move to a calm and quiet place. Sit down and breathe slowly. Try focusing on your breathing to distract yourself
  • Do not berate yourself - this is a medical condition and it’s out of your control. Talk to a friend, family member or psychologist to help you when you’re feeling blue 
  • After a PLC episode is over, do not return to your routine immediately. Take a few minutes to rest. Try putting your head down for a minute to relax


References

  1. American Stroke Association [internet]: Texas, USA AHA: Pseudobulbar Affect (PBA)
  2. Josef Parvizi et.al. Pathological laughter and crying: A link to the cerebellum . Volume 124, Issue 9, September 2001
  3. Parvizi J et.al. Diagnosis and management of pathological laughter and crying. Mayo Clin Proc. 2006 Nov;81(11):1482-6. PMID: 17120404
  4. Carl Hoegerl et.al. Pathological Laughter in a Patient With Multiple Sclerosis. The Journal of the American Osteopathic Association, August 2008, Vol. 108, 409-411.
  5. Kerry L. Coburn et.al. Neuroanatomy of Pathological Laughing and Crying: A Report of the American Neuropsychiatric Association Committee on Research. J Neuropsychiatry Clin Neurosci 21:1, Winter 2009

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